Congestive Heart Failure

Question 1

What are contributing factors to CHF

Answer 1

Hypertension, obesity, DM, Age, Valve Problems, Left ventricular hypertrophy, and remodling of the heart post-MI.

Question 2

Diagnostic test for CHF

Answer 2

Echocardiogram

Question 3

Hypertension->LVH->CHF

Answer 3

SBP>160mmhg increase the thickness of the LV wall leading to LVH. LVH is a compensatory mechanism of the heart to increase the contractility of the heart. LVH decreases the ability to pump blood efficiently leading to CHF due to stiffness a decreased ability to relax during diastole. There is also a reduction in stroke volume.

Question 4

S/S of CHF

Answer 4

SOB, Increased JVD, Edema, Pleural effusion, Pulmonary edema, Ascites, and exercise intolerance. Syncope, paroxysmal nocturnal dyspnea.

Question 5

Right sided failure

Answer 5

Backward failure of RV leads to congestion of systemic capillaries. Excess fluid accumulation in the body (ascites, peripheral edema, anasarca). JVD. Liver congestion leads to congestive hepatopathy, jaundice, and coagulopathy problems.

Forward failure-Tiredness and fatigue due to a build-up of CO2, palpitations due to a compensatory mechanism of the heart.

Question 6

Left sided heart failure

Answer 6

Systolic failure-heart cannot push oxygenated blood to the rest of the body.

Diastolic failure-fluid collects in the lungs, leading to pulmonary edema. Dyspnea will follow.

Question 7

Lifestyle changes->CHF

Answer 7

Fluid restriction-Heart cannot manage and increase in fluid intake
Sodium restriction-sodium causes vasoconstriction + increases fluid retention.

Question 8

ACEI+ARB->CHF

Answer 8

ACE+ARB work on the RAAS to decrease the level of aldosterone. Leading to a decrease in fluid retention.

Question 9

Beta-adrenergic blocking agents->CHF

Answer 9

Used for patients with HRrEF. BB reduce the sinus rate by blocking the activity of catecholamines at beta-1-receptors in the SA node therefore lowering heart rate and increasing the length of diastole and decreasing myocardial oxygen demand.

Question 10

Diuretics->CHF

Answer 10

Due to the fluid volume overload, diuretics help decrease the level of fluid within the body. Spironolactone can be used as potassium-sparing diuretics.

Question 11

Digoxin->CHF

Answer 11

Ionotrope (Cardiac Glycoside). Works by inhibiting the NA-K-ATPase pump in myocardial cells. Leading to a rise in the intracellular calcium concentration. Results in improved isolated myocyte contractile performance.

Slows conduction of AV-node to increase the amount of time spent in diastole.